Summary and comments:

Guyuron's procedure may prove to be a possible preventive option, but the data released thus far is hardly conclusive. The study discussed above had no control group. It was a small group of only 69 patients, and they were all from the same treatment center. The 29% of participants who reported total elimination of Migraine may seem impressive as does the 59% who reported a significant decrease in Migraines until you consider the following:

• It's not unusual to see the placebo rate (the percentage of participants who respond positively in a trial even though they receive an inactive substance or sham procedure) in trials exceed 30%.
• Guyuron's surgical patients aren't drawn from the total Migraine population, but from a smaller subpopulation. His procedure is performed only on patients who had positive results with Botox injected into their "trigger sites." If study participants had been drawn randomly from ALL Migraineurs, the success rates would have been dramatically different.

Dr. Samuel Lin, a plastic surgeon at Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical school says,

"It is too soon to tell. More studies will need to be done."²

He says, as I have, that the procedure has potential, but

"...it is still early in the process of seeing if this is truly the treatment of choice for the majority of patients."²

Dr Lin says that before the surgical procedure gains widespread acceptance, it should be compared to Botox and other current treatments, and it should only be done after other less invasive treatments are tried and found to fail.

According to the Lasalandra article, "Guyuron agreed that the treatment is not a good option for those with infrequent migraines or for those who respond to preventative treatments."

As with any research, this research needs to be replicated with a larger group of subjects and in other locations before the treatment moves into the realm of "accepted" treatments. It may be that, for the subset of Migraineurs for whom Botox works, this procedure will prove to be a viable option. However, it must be remembered that Guyuron's trials have been limited to that subset, the study group was very small, and the research has yet to be replicated.

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Resources:

¹ Press release. "Surgery potentially best option for severe migraine headaches." Cleveland. University Hospitals Case Medical Center. October 24, 2009.

² Lasalandra, Michael. "Jury Still Out On Forehead Lifts To Treat Migraines." WCVB-TV5 Boston. October 26, 2009.

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© Teri Robert, 2009. Last updated August 3, 2009.